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Contact Information

COUNTRYSIDE MEDICAL CLINIC, LLC
1959 200TH ST
RED OAK, IA51566-3218
 Phone: 712-629-0040
 Fax: 712-566-5049
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Primary Care

261QP2300X
Indicates primary specialty

NPI Profile & details for COUNTRYSIDE MEDICAL CLINIC, LLC

NPI Number 1396103685
LBN Legal business name COUNTRYSIDE MEDICAL CLINIC, LLC
Authorized official KIMBERLY RINES - (NURSE PRACTITIONER)
Entity Organization
Organization subpart 1 No
Enumeration date 02/02/2016
Last updated 12/12/2018 - About 7 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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